Simultaneous gastroscopy and colonoscopy for the diagnosis of gastrojejunocolic fistula - 22/08/11
Doi : 10.1016/j.gie.2006.12.052
| Commentary A barium enema was diagnostic in this case, and EGD/colonoscopy was unrevealing of the cause. Moreover, the particular manner of endoscopy used here reminded me of the use of a spit to hold food while it is being cooked over an open fire or roasted in an oven. Because the gastrojejunostomy was created surgically and the jejunocolic fistula was likely the result of a pathologic process, the term gastrojejunocolic fistula seems to me a bit misleading. Nonetheless, such fistulas, although uncommon, usually result from peptic ulcer disease; neoplasm; foreign bodies; Crohn’s disease; diverticulitis; infections, such as histoplasmosis and actinomycosis; and surgery. Symptoms are diarrhea and malabsorption with weight loss, usually from a combination of short-circuiting the length of the small intestine and bacterial overgrowth, colonic bacteria spilling over the entire proximal GI tract. Such fistulas usually are not negotiable with endoscopes because of their complex routings. In this case, the simultaneous use of 2 endoscopes undoubtedly identified the fistula pathway but was such skewering really necessary? Perhaps the endoscopic team just didn’t trust each other. Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2007
American Society for Gastrointestinal Endoscopy. Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 66 - N° 3
P. 597-598 - septembre 2007 Retour au numéro
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